Cancer Patient Safety Learning Laboratory (CaPSLL): Preventing Clinical Deterioration in Outpatients

癌症患者安全学习实验室 (CaPSLL)：防止门诊患者临床恶化

• 批准号: 10254301
• 负责人: DANIEL Joseph FRANCE
• 金额: $ 59.35万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2023-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10254301
• 关键词: Cancer; Patient; Safety; Learning; Laboratory

Project Summary/Abstract A common cause of preventable harm is the failure to detect and appropriately respond to clinical deterioration. Timely intervention is needed, particularly in medically complex (e.g., cancer) patients, to mitigate the effects of adverse events, disease progression, and medical error. This challenging problem requires effective clinical surveillance, early recognition, timely notification of the appropriate clinician, and effective intervention. In the hospital setting, “failure to rescue” (FTR) is a recognized safety failure. To address FTR, hospitals have introduced new tools and processes (e.g., continuous monitoring, early warning systems, and `Rapid Response' teams). Yet, `death in bed' remains common. The Vanderbilt-Ingram Cancer Center, in collaboration with human factors and systems engineering faculty in the Center for Research and Innovation in Systems Safety (CRISS), as well as faculty in our Schools of Engineering and Management, will create the Cancer Patient Safety Learning Laboratory (CaPSLL). We will partner with surgeons, oncologists, nurses, staff, and adult patients with lung and head or neck cancer recovering from and/or undergoing treatment as outpatients, and their lay caregivers, to more reliably detect and respond more effectively to unexpected clinical deterioration. The details that follow in this proposal are based on our current understandings but will be modified as we employ a systems engineering oriented user-centered design (UCD) process to analyze, design, develop, implement, and evaluate innovative tools and processes to address this complex patient safety problem. We will achieve this through three Specific Aims: 1) To create and refine software tools and a predictive model for a surveillance-and-response system to prevent harm from unexpected all-cause clinical deterioration in outpatients receiving cancer treatment; 2) To create and refine processes and training that engage patients and their caregivers as active and reliable participants in detecting and reporting potential clinical deterioration. We will apply high reliability organizational (HRO) principles and theories to develop processes and training for the relevant “team” – the cancer patients, their caregivers, and the clinicians who need to respond to signals from the surveillance system; and 3) To implement in the operational environment and formally evaluate the integrated detection and response tools and processes. We hypothesize (H1) that this system will decrease the likelihood and severity of unplanned treatment events (UTE; e.g. hospital admission). Further, with the incorporation of a patient/family focused HRO framework, we hypothesize that the system will increase non-routine event (NRE; deviations from optimal care) reporting (H2) and decrease clinician response time (H3). The resulting tools, methods and predictive model will be scalable to other cancer types as well as being generalizable to other institutions and to other high-risk outpatient populations (e.g., heart failure).

项目摘要/摘要 可预防伤害的共同原因是未能检测并适当应对临床 恶化。需要及时干预，特别是在医学复杂（例如癌症）患者中 减轻不良事件，疾病进展和医疗错误的影响。这个挑战问题 需要有效的临床监测，早期识别，及时通知适当的临床， 和有效的干预。在医院环境中，“未能营救”（FTR）是公认的安全失败。 为了解决FTR，医院引入了新的工具和流程（例如，持续监视，早期 警告系统和“快速响应”团队）。然而，“床上的死亡”仍然很普遍。 Vanderbilt-Ingram癌症中心与人为因素和系统工程合作 系统安全研究与创新中心（Criss）的教职员工以及我们的教师 工程和管理学校将创建癌症患者安全学习实验室 （capsll）。我们将与外科医生，肿瘤学家，护士，员工和成人患者合作 或从门诊病人及其外行护理人员中恢复和/或接受治疗的颈部癌 更可靠的检测和对意外临床细节的反应。细节 遵循此提案是基于我们当前的理解，但会在我们员工a雇员时进行修改 以用户为中心的系统工程以分析，设计，开发，实现， 并评估创新的工具和过程，以解决这一复杂的患者安全问题。 我们将通过三个特定目标来实现这一目标：1）创建和完善软件工具和 监视和响应系统的预测模型，以防止出乎意料的全因危害 接受癌症治疗的门诊患者的临床确定； 2）创建和完善流程和 培训使患者及其护理人员成为积极且可靠的参与者检测和 报告潜在的临床定义。我们将应用高可靠性组织（HRO）原则 以及为相关“团队”开发过程和培训的理论 - 癌症患者及其 护理人员和需要回应监视系统信号的临床医生；和3）到 在操作环境中实施并正式评估集成检测和响应 工具和过程。我们假设（H1）该系统将降低 计划外的治疗事件（UTE；例如医院入院）。此外，合并 患者/家庭以HRO框架为本，我们假设该系统将增加非列表事件 （NRE；偏离最佳护理）报告（H2）并减少临床反应时间（H3）。这 最终的工具，方法和预测模型将可扩展到其他癌症类型以及 可推广到其他机构和其他高风险门诊群体（例如心力衰竭）。